Goals of the guidelines are
to assure students’ safety and rights, the safety of other students, and to
offer safe services performed in accordance with nursing practice standards
which include nursing care planning, delegation, training, and monitoring of
direct service providers and unlicensed assistive personnel.

These guidelines will
clearly identify roles and responsibilities of Sarasota County Core Team members
consisting of, but not limited to: family, student, school RN, health room
aides, food and nutrition staff, educational personnel, school administration,
transportation and the physician. They will ensure that emergency medical
services (EMS) are engaged immediately in the sequence that puts the safety of
the child first.

These guidelines were developed through the collaborative
efforts of the School Nurses of the Florida Department of Health in Sarasota County and the
School Board of Sarasota County, the School Board of Sarasota County Food and
Nutrition Services, and the Sarasota County School Health Advisory Board.

Life-threatening allergies and associated anaphylaxis are
on the rise and are a growing public health concern in the United States.
“Anaphylaxis refers to a collection of symptoms affecting multiple systems in
the body. The most dangerous symptoms include breathing difficulties and a drop
in blood pressure, or shock, which are potentially fatal. Common examples of
potential life-threatening allergies are those to foods and stinging insects.
Life-threatening allergic reactions may also occur to medications, latex rubber,
in association with exercise” or may be of an unknown cause (idiopathic).
(Position Statement from American Academy of Allergy, Asthma and Immunology (AAAAI)
Board of Directors:” Anaphylaxis in Schools and Other Childcare Settings”-1998)

From 1997 to 2007, the prevalence of reported food allergy
increased 18% among children. In 2007, approximately 3 million children in the
US were reported to have food allergies with the highest incidence
(approximately 6%) occurring in young children under the age of three. Eight
foods account for 90 percent of all food-allergic reactions in the U.S.: milk,
eggs, peanuts, tree nuts (e.g., walnuts, almonds, cashews, pistachios, and
pecans), wheat, soy, fish, and shellfish. Food allergies are the leading cause
of anaphylaxis outside of the hospital setting. (AAAAI- "Allergy
Statistics"-2009)

(AAAAI-"Allergy Statistics" 2009). For drug allergies, penicillin is the most common allergy
trigger. Latex allergy affects between 5-15% of the health care workers, but
less than 1% of the general population. (AAAAI-"Allergy Statistics"-2009)

There is no cure for life-threatening allergies. The most
important aspect of the management of children with life-threatening allergies
is strict avoidance. School environments provide numerous opportunities for
exposure to allergens (e.g. classrooms, recess, athletic events, parties,
snacks, arts and crafts projects, incentives, buses). A school environment
for a child diagnosed with a life-threatening allergy needs to be created to
prevent exposure and to recognize and manage a reaction if exposure occurs.

“A combination of state and
federal laws guarantee the access to education and to health and other support
services that enable students with special health needs to attend school.
Section 381.0056 F.S. mandates basic school health services for all students,
s.1006.062 F.S. mandates assistance with medication and special procedures, and
s.1002.20 (3)(i) F.S, the Kelsey Ryan Act, allows public school students
with a history of life-threatening allergic reactions to carry an epinephrine
auto-injector and self-administer epinephrine while in school, participating in
school-sponsored activities or in transit to or from school or school-sponsored
activities if the school has been provided with parental and physician
authorization.” (Technical Assistance Paper (TAP): Implementing the Kelsey Ryan
Act - May 2006)

“The school district determines
whether students with life threatening allergies should receive services under
Section 504 (Rehabilitation Act of 1973), Title 11 of the Americans with
Disability Act (ADA), or the Individuals with Disabilities Education Improvement
Act of 2004 (IDEIA). If the district determines that the student should receive
services under IDEIA, the school staff documents the related aids and services
needed in the student’s IEP. If it is determined that the student is eligible
under s. 504, the school staff develops a Section 504 Plan to document the
related aids and services school district will provide. Attach the IHP
developed by the school RN to either plan to document the healthcare services
required by the student” (TAP, May 2006).

Note: IDEA was reauthorized,
revised, and renamed in 2004. The Individuals with Disabilities Education
Improvement Act of 2004 (IDEIA) became effective July 1, 2005.

“Nursing services in Florida and
Florida schools are regulated by the provisions of
The Nurse Practice Act,
Chapter 464, F.S., which specifies nursing training and qualifications, practice
parameters, guidelines for the legal use of health aides or unlicensed assistive
personnel in care provision” (TAP, May 2006).

For further clarification of the
nurse’s role in delegation and supervision, see Chapter 64B9-14.001-003, Florida
Administration Code (F.A.C.). This rule describes the “Delegation of Tasks or
Activities” (Chapter 64B9-14.002, F.A.C.), and the “Delegation of Tasks
Prohibited” (Chapter 64B9-12.003, F.A.C.). Internet sites for text of state and
federal laws that apply to children with special health care needs are provided
in the reference section of this document. (TAP, May 2006)

Allergic reactions begin when a predisposed student
eats, inhales, or has contact with an allergen/protein that triggers an allergic
response. The most common allergic response is when the immune system in the
body responds by producing an antibody, IgE, to a particular allergen/protein.
“The antibody circulates throughout the body sensitizing mast cells in the GI
tract, lungs, etc. “ (FAAN, 2005) All of this happens the first time the student is exposed
to the allergen/protein, but commonly there are no symptoms until the second
exposure.

“The next time the student eats, touches or inhales
the offending allergen/protein, the immune systems sensitized cells protect the
body from the

“dangerous invader” by releasing histamine and
other chemicals. As a result, the individual experiences symptoms of an allergic
reaction.” (FAAN, 2005)

Even trace amounts of an allergen/protein can
produce a reaction.

Symptoms that the student will experience depend on
the location in the body in which the histamine is released. There is no way to
predict how a reaction will develop. The severity of symptoms can change very rapidly
and become a life- threatening reaction.

“Anaphylaxis is the
potentially life-threatening medical condition occurring in allergic individuals
after exposure to their specific allergens. Anaphylaxis refers to a collection
of symptoms affecting multiple systems in the body. These symptoms may include
one or more of the following” (FAAN, 2005):

Typical Allergy Symptoms

Skin Symptoms

Gut Symptoms

Respiratory Symptoms

Cardiovascular

Neurological

Hives

Cramps

Itchy, watery eyes

Reduced
blood pressure

Feeling of impending doom

Swelling

Nausea

Runny nose

Fainting

Weakness

Itchy red rash

Vomiting

Stuffy nose

Shock

Eczema flare

Diarrhea

Sneezing

Chest
Pain

Coughing

Itching or swelling of
lips, tongue, throat

Change in voice

Difficulty swallowing

Tightness of chest

Wheezing

Shortness of breath

Repetitive throat clearing

“The most dangerous and potentially fatal symptoms include
breathing difficulties and a drop in blood pressure or shock. Common
examples of potentially life-threatening allergies are those to food and
stinging insects. Life-threatening allergic reactions may also occur to
medications, latex rubber, in association with exercise, or may be of an unknown
cause” (www.foodallergy.org/anaphylaxis.html).

“For some individuals, the reaction
begins slowly and gradually gets worse, for others it develops more quickly and
can become life threatening within a few minutes, which is why all reactions
need to be taken seriously and treated promptly. Early administration of
epinephrine is crucial to treating anaphylactic reactions. It is better to
err on the side of caution, if in doubt give the epinephrine. (FAAN, 2005).

“Anaphylaxis can occur
immediately or up to two hours following allergen exposure. In about a third of
anaphylactic reactions, the initial symptoms are followed by a delayed wave of
symptoms two to four hours later [and possibly longer].”
“This combination of an
early phase of symptoms followed by a late phase of symptoms is defined as a
biphasic reaction. While the initial symptoms respond to epinephrine, the
delayed biphasic response may not respond at all to epinephrine and may not be
prevented by steroids. Therefore, it is imperative that following the
administration of epinephrine the student be transported by emergency medical
services to the nearest hospital emergency department even if the symptoms
appear to have been resolved” (MaDOE, 2002).

Children have unique ways of describing
their experiences and perceptions, and allergic reactions are no exception.
Precious time is lost when adults do not immediately recognize that a reaction
is occurring or don’t understand what a child is telling them.

Some children, especially very young ones,
put their hands in their mouths or pull or scratch at their tongues in response
to a reaction. Also, children’s voices may change (e.g., become hoarse or
squeaky), and they may slur their words.

The following are examples of the words a
child might use to describe a reaction:

"This food's too spicy."

"My tongue is hot [or burning]."

"It feels like something’s
poking my tongue."

"My tongue [or mouth] is
tingling [or burning]."

"My tongue [or mouth] itches."

"It [my tongue] feels like
there is hair on it."

"My mouth feels funny."

"There's a frog in my throat."

"There’s something stuck in my
throat."

"My tongue feels full [or
heavy]."

"My lips feel tight."

"It feels like there are
bugs in there." (to describe itchy ears)

"It [my throat] feels
thick."

"It feels like a bump is
on the back of my tongue [throat]."

If you suspect that your child is having
an allergic reaction, follow your doctor's instructions.

A food allergy can develop from any
food. A food allergy is a medical condition involving the immune system. Food
poisoning, food intolerance, food aversions, or phobias are commonly mistaken
for but are not considered food allergies because there is no immune response.
Eight foods account for 90 percent of all food –allergic reactions in the U.S.;
milk, eggs, peanuts, tree nuts, (e.g., walnuts, almonds, cashews, pistachios,
pecans), wheat, soy, fish, and shellfish. (www.foodallergy.org/section/common-food-allergens1)

“There is no cure or preventive
medication available for food allergy. Avoidance of the food is the only way to
prevent a reaction from occurring. (FAAN,2005)

“Most individuals who have
experienced a food-allergic reaction knew what they were allergic to and
unknowingly ate that food. In most cases, the allergy-causing food was an
unexpected ingredient in another food. Another potentially serious cause of
allergic reactions is cross contact from an allergy –causing food to a non
allergy-causing food during food processing or preparation. “ (FAAN, 2005)

There is no way to predict how
a reaction will develop. The severity of symptoms can change very rapidly
and become a life-threatening reaction. Nevertheless with food
allergies, “there are three specific pieces of a patient’s history that signify
an increased risk for a severe reaction: a record of severe reactions in the
past, an allergy to peanuts and or tree nuts, and the presence of asthma” (The
Food Allergy & Anaphylaxis Network (FAAN) Food Allergy News Sample)

School environments provide numerous
opportunities for exposure to food allergens (e.g. classrooms, recess, athletic
events, parties, snacks, arts and crafts projects, incentives, buses). A
school environment for a child diagnosed with a life- threatening allergy needs
to be created to prevent exposure and to recognize and manage a reaction if
exposure occurs.

The
Food Allergy Team should include, but not be limited to, the School
Nurse, Principal, Food Service Supervisor, and Teachers. A meeting
should occur before the first day of school.

The parent shall provide a signed
Medication/Treatment Authorization Form which outlines how to treat an
allergic reaction.

The student shall not share/trade food,
utensils, cups, or water bottles.

The Team should discuss the foods to be
avoided, the symptoms of an allergic reaction, and what to do if a
reaction occurs.

The Team should develop management
strategies for lunchtime, snacks, field trips, and class parties.
Please see the
School Board website - Food and Nutrition Services to download the Menu
Modification Medical Statement. See the
Forms
chapter for documents and signs.

The teachers should review lesson plans
which include food. Non-food substitutes should be made.

The teachers should have a plan to alert substitutes to the presence of
a student with a life-threatening food allergy.

Parents and food service staff should
work together in reviewing menus and ingredients to determine what food
students can and cannot eat, the issue of cross-contamination during
food preparation should be reviewed and how the student is going to be
identified in the lunch line.

A procedure for cleaning lunch tables
and the surrounding areas should be established to remove any food
allergens.

Teach proper hand washing and allow
time to complete the procedure.

The School Nurse will educate the bus
driver, classroom aides, and others concerning the symptoms of an
allergic reaction and what to do if a reaction occurs.

Latex allergies are a reaction to the
proteins in natural rubber latex, a milky sap produced by the Hevea Braziliensis
rubber tree. There is an increased prevalence of latex allergies in children who
have had multiple surgeries early in life and with healthcare workers.

Latex can result in an allergic
reaction by direct contact with products containing latex such as balloons,
elastic in clothes, rubber bands, pencil erasers, etc. Latex can also become
airborne and cause respiratory symptoms. For example as latex gloves are used,
the proteins in latex may be carried on cornstarch powders that are used as a
lubricant on some gloves resulting in respiratory symptoms.

In most cases, latex allergy develops
after repeated exposure to natural rubber latex products. Symptoms usually
occur immediately following contact with latex. Allergic reactions can vary from
mild to life threatening. There is no cure for latex allergy so avoidance of
known latex allergens is the best method of treatment.

For lists of latex alternatives and
latex-free products, visit the American Latex Allergy Association website at
www.latexallergyresources.org. Another resource is the CDC Latex Allergy
Hotline (1-800-356-4674 or
www.cdc.gov/niosh/latexfs.html. To check out a product’s contents for sure,
call the manufacturer.

The School RN and Health
Room Aide should have the option of vinyl/nitrile gloves in the Health Room.

Food servers should avoid
use of latex gloves.

Review the classroom
environment as well as class projects.

Often a student with a
latex allergy will also have the potential for anaphylaxis by coming in
contact with bananas, kiwi, or avocado.

Insect allergies involve
an allergic reaction associated with the venom or toxin induced when bitten or
stung by an insect. There are thousands of biting and stinging insects in our
environment, however the insects most known to produce an anaphylactic reaction
are fire ants, bumble bees, honey bees, wasps, yellow jackets and hornets (Selekman,
2006).

“To decrease the
chance of insect stings, the following measures should be followed:

“Although rare,
exercise can cause anaphylaxis. Oddly enough, it does not occur after every
exercise session and in some cases, only occurs after eating certain foods
before exercise. Food-associated exercise-induced anaphylaxis is caused by
a combination of eating a particular food, often celery or wheat, plus exercise
within an hour or two after eating.” (AAAAI, 2010)

Class schedule may need to be
modified in order to coordinate meals and snacks with P.E. class or recess.

If a specific food is connected
with a reaction, this food should be avoided as much as possible when increased
physical activity is anticipated.

This form of anaphylaxis involves an allergic reaction to an unknown
substance or combination substances and/or environmental factors. The specific
allergen has not been identified therefore planning is complicated. (Lechner and
Grammer, 2010)

Sarasota County School District
supports environmental policies that limit possible allergens in the
facilities. The use of airborne sprays that propel possible allergens in the
air should be eliminated in all areas in which students visit. Air fresheners,
perfume, and deodorizers, especially of food origin are examples of products to
avoid.

“It is most likely that, in the face of a natural disaster or
emergency, all students will be sent home from school. However, in the event
that environmental hazards exist that would prevent the student from leaving the
school or that may precipitate an allergic episode, emergency medical services
must be aware that environmentally fragile students with life-threatening
allergies may be in the affected school. Every effort should be made to remove
the student with life-threatening allergies safely, and ensure that emergency
medications are available to the student” (TAP, 2006).

with a Life-threatening Allergy

Medically
diagnosed life-threatening allergies are managed using a core team approach (see
Student Life-Threatening Allergy Notification Flow Chart). The team’s goal
is to ensure the safety and well being of the student. Upon identification of a
student with a life-threatening allergy, members of the core team implement
these guidelines and take responsibility for their role as outlined below. (The
majority of the following information on Responsibilities of the Core Team was taken from
the Technical Assistance Paper (TAP): Implementing the Kelsey Ryan Act - May
2006)

The physician/healthcare
provider manages the medical care of the student with life threatening
allergies. The physician should provide information and guidance to the school
RN to use in developing the Individual Health Plan (IHP). Physicians should
take into consideration the resources available in the school to assist students
with their care. To safeguard student health, the physician should:

Provide the school
RN with all medical documentation as requested, including written orders on the
Medication/Treatment Authorization Form and emergency information
specific to the needs of the student which should include steps to ensure
reliable, prompt access to an epinephrine auto -injector.

Be accessible by
phone or fax to review or contribute to the IHP and for emergency orders.

Educate the
student and the parent/guardians regarding prevention and management of allergic
exposure.

Determine
the level of self-care allowed based on the student’s knowledge, developmental
level, and abilities.

The school health policies should
delineate roles that promote partnership between parents and the school.
According to the School Health Services Act (Section 381.0056 F.S.), “School health
services supplement, rather than replace, parental responsibility.”

For children to receive
safe, consistent services while in school, it is important for parents and
guardians to:

Inform the
school as soon as possible when a student is newly diagnosed as having an
allergy or when a previously diagnosed student enrolls in a new school.
Ideally, parents should work with the school staff prior to their child’s
admission to ease the student’s transition into the school environment.

Participate in the IHP conference
as soon as possible after diagnosis and at the start of each school year.

Work with the school core team to
develop a plan that accommodates the child’s needs throughout the school
including the classroom, the cafeteria, after-care programs, during
school-sponsored activities and on the school bus.

Provide and
hand carry all medications and supplies associated with the medical
management of the student’s allergies to the school health room. The parent
may want to consider filling extra prescriptions for epinephrine and
storing them in different locations throughout the school.

Notify school core team of any
changes of enrollment in after care programs, or school sponsored activities.

Provide written medical
documentation for nutritional changes signed by the student’s physician and any
changes as indicated.

To remain active and
healthy, the student with life-threatening allergies must assume some of the
responsibilities in following the medical management plan designed by their
health care provider as well as their IHP. Medication and supplies must be
handled safely to prevent accidental injection of other students or staff. The
student should:

Be proactive in the care and
management of their allergies and reactions based on their developmental level.

Demonstrate
competence in the use of auto injector (age-appropriate as per
physician’s order).
See:

Review and update the IHP whenever
there is a change in medical management or the student’s response to care.

Educate the core
team members regarding signs and symptoms of anaphylaxis and how to
implement the emergency response plan.

Administer and activate emergency
procedures.

Provide a developmentally
appropriate presentation for classmates of the child regarding the allergy, if
applicable with parent and student permission.

Coordinate plan of care with
physician and family annually.

Collaborate with the principal to
provide above services.

Maintain appropriate documentation
of the training and care provided, and monitor the documentation of services
provided by others.

Respect the student’s
confidentiality, right to privacy and serve as the student advocate.

Criteria for Safe Nursing Delegation

“The safety of the student
is the primary consideration in the delivery of all health-related services
provided in the school. The school RN is responsible for training and
monitoring the individual designated to perform these services.
Section 1006.062(1)(a), F.S. specifies that the school principal designates school staff
to perform health services in the absence of the nurse. However, only the
professional nurse may delegate the authority based upon nursing judgment and
suitability of the individual to perform the task or activity to be delegated.
Recognition of this distinction between designation to perform and
delegation of nursing tasks is critical to the provision of safe care in the
schools” (TAP, 2006).

Health room aides (HRA)
perform under the administrative supervision of the School Principal and have
the guidance and direction of the school RN for health related issues. The HRA
performs services within the school health services program according to the
written policies and procedures in the School Health Services Manual.

The HRA will be familiar with the
IHP of the student with life-threatening allergies.

Be trained (by
the school RN) about the signs and symptoms of anaphylaxis and
demonstrate competency in the use of the following:

Avoid cross-contamination from
snacks or other foods, including the possibility of extra table cleaning
precautions.

Make accommodations within means of
the National School Lunch Program.

Food service personnel will notify
FNS manager or lunchroom aide if a student appears distressed.

FNS manager and lunch room aide
should be knowledgeable about
the signs and symptoms of an allergic reaction and how to implement the
emergency response plan if a student is exposed to a life-threatening
allergen.

Receive child specific
training by the School RN about the signs and symptoms of an allergic
reaction and how to implement the emergency response plan if a student
is exposed to a life-threatening allergen.

Keep information about their
student’s allergies in a place where a substitute will have easy access.

Be familiar with the IHP of
students in their class.

Inform substitute teachers about the student.

Support students without violating
their sense of privacy.

Avoid cross-contamination of
allergens in environment.

Promote good hand-washing
techniques allowing adequate time for personal hygiene.

Promote tolerance for differences
to discourage harassment.

Provide a physical environment
conducive to children with allergies.

Review lesson plans to reduce allergens in areas such as
science experiments or art projects as examples.

Notify the parent or guardian of a
student with food allergies that they are responsible for providing classroom
snacks intended for use during the school day.

The Principal or his/her
designee should enforce district policies to assure implementation of the
services needed for the student’s plan of care as follows:

Be aware of the federal and state
laws governing the educational requirements for students with special health
needs.

Promote tolerance for differences
to discourage harassment.

Provide a physical environment
conducive to children with allergies.

Coordinate with the school RN to
make sure medications are appropriately stored, and be sure that an emergency
kit is available containing a physician’s order for epinephrine and /or
Benadryl.

Establish an emergency protocol
with Core Team.

Designate school personnel to be
trained to administer medications in accordance with state statutes governing
the administration of emergency medications.

Ensure that school staff
interacting with the student on a regular basis attends scheduled training in
order to understand life-threatening allergies, recognize symptoms and know what
to do in an emergency.

The designated school bus
driver should receive notification by the Bus Transportation Director of
a student who has life-threatening allergies and should know how to implement the emergency response plan if a
student is exposed to a life-threatening allergen.

Identification of
the high risk student

The school bus driver must be
knowledgeable about activation of emergency services (911) and have the means of
communicating emergency calls.

The School Board of Sarasota County supports each
student’s rights and seeks a balance for each student to support free choice in
food selections and a safe environment for those students with life-threatening
allergies. Efforts will be made to create a safe environment for the
students to include environmental cleaning, safe zones in cafeteria areas and
thoughtful and kind communication regarding possible limitation of offending
allergens in the classroom during special snack times. Communication to
classmates and their parents will be done after team review and consensus by the
school RN, administration, teachers and student’s parents and will be worded to
include consideration for all students.

(See sample letter - Foods to Avoid Bringing to
School)

With
the permission of the student and parents/guardians, the teacher or the school
RN may educate the class about the special needs of an individual with life
threatening allergies and use this as an opportunity to educate students
regarding allergen avoidance and the need
for immediate notification if a student is exposed to an allergen. Emphasize
what the student can eat as well as what must be avoided. (See
food allergy - sample lesson plan and
food allergy signs in the Forms Chapter.

Be a PAL: Protect A Life™ From
Food Allergies is an educational awareness program designed to help parents and
educators teach students what food allergies are and how to help their friends
who have food allergies. (See Food Allergy and Anaphylaxis Network-www.foodallergy.org/pal.html
and food allergy-Be a PAL: Protect A Life™ From Food Allergies Poster.

“Chronic illness in children
invariably poses many challenges to families. As children proceed through
stages of cognitive, emotional and social development, their emotional responses
and self-management strategies evolve.

If a life-threatening allergy
is identified in a young child, the burden of prevention is initially fully upon
parents. There may be an increase in anxiety around age 7 when a child’s
cognitive development allows them to appreciate the possibility of serious
reactions and as they move toward more independent functioning at school and
with peers.

The transition from childhood
to adolescence marks another time of increase risk. Although fatal food-allergy
reactions are rare, they are most common among teenagers and young adults. This
may be due to adolescents’ willingness to take risks, to faulty perceptions of
risk, testing limits, or because they are more fearful of not fitting in
socially than they are of having an allergic reaction. “(Greenberger, April 2010)

In addition, how other
students react to the student who has a life threatening allergy impacts the
child’s emotional health. “Beware of bullies who harass allergic students,
threaten to make them eat an “unsafe “food” when there is a food allergy, or
threaten them with any type of life-threatening allergen.” If there is a
problem, such as harassment and bullying, it should be discussed with the guilty
student and the parents as soon as possible. Be sure everyone understands this
type of behavior is inappropriate” and follow the harassment/bullying procedure
as per school guidelines. (FAAN,2005)

Because an anaphylactic
reaction can occur at any time or anyplace, it is imperative that members of the
core team are familiar with their roles/responsibilities and be comfortable with
administering and/or supervising treatment.

The Epinephrine auto-injector
is the treatment of choice for a life-threatening anaphylactic reaction.
However, treatment when prescribed
is always student specific. Some physicians are prescribing Benadryl
(antihistamine) along with the auto-injector. The antihistaminein conjunction with the epinephrine may be given in
an effort to decrease the symptoms and severity of the reaction. Antihistamines
however should not be used in place of epinephrine. It is important that each
member of the core team knows specifically what the treatment is for that
particular student.

Once epinephrine is used, call EMS
and “request an ambulance equipped with epinephrine and a responder trained to
administer this medication” (FAAN, Food Allergy Action Plan) Send the used
epinephrine auto-injector with the student to the Emergency Room.

The IHP will include age
appropriate accommodations for the student medically approved per the
Medication
/Treatment Authorization Form to have epinephrine administered or self-administered in
accordance with the Kelsey Ryan Act. The school RN in conjunction with school
administrator and teacher will assess ability to perform self-administration,
maturity level to function in an emergency, past life-threatening allergy
episode and history of action taken by the student. Once safety and performance
of the student has been assessed, the student can carry epinephrine in a rigid
container attached to the student’s body. A second dose of medication is
encouraged to be available at the school in case the student forgets it.

“The auto-injector is a
disposable drug delivery system with a concealed needle that is spring
activated. The active ingredient is epinephrine, the treatment of choice in
allergic emergencies (anaphylactic reactions) because it quickly constricts
blood vessels, relaxes smooth muscles in the lungs to improve breathing,
stimulates the heartbeat and works to reverse hives and swelling around the face
and lips.” (http://www.epipen.com)

Initial symptoms of
anaphylaxis may represent a potentially fatal outcome and should be treated as a
medical emergency, whether the symptoms occur gradually or suddenly. Even mild
symptoms may intensify rapidly, triggering severe and possibly fatal shock.
Usually, symptoms occur immediately following the sting or bite; death may occur
within minutes. Symptoms, which often vary according to individual response,
include the following:

Sudden sense of uneasiness/anxiety

Flushed skin

Widespread hives

Itching around the eyes

Dry, hacking cough

Constricted feeling in throat/chest

Wheezing

Facial edema or swelling (i.e.
lips, tongue, and eyes)

Abdominal pain

Nausea or vomiting

Difficulty breathing

Hoarseness or thickened speech

Confusion

Feeling of impending doom

These symptoms may escalate
swiftly to anaphylactic shock characterized by cyanosis, reduced blood pressure,
collapse, incontinence, and unconsciousness. Epinephrine given after the onset
of low blood pressure may not prevent death.” (http://www.foodallergy.org:
Information About Anaphylaxis)

Do not hesitate to use
the auto-injector if you suspect a

serious allergic
reaction, "err on the side of caution” (FAAN, 2005)

Epinephrine is
available by prescription only. Epinephrine needs to be stored in a dark place
at room temperature (59-86 degrees Fahrenheit). Exposure to light and extreme
temperatures may inactivate the medication. Check the medication color (it
should be clear) and expiration date. Notify the student’s parents when a
replacement is needed. (FAAN, 2005)

American
Academy of Allergy, Asthma and Immunology (AAAAI) “Patients
& Consumers Center: Tips to Remember: What is Anaphylaxis” Retrieved
July 30, 2010 from www.aaaai.org/patients/publicedmat/tips/whatisanaphylaxis.stm

EpiPen
Training and Instructions: www.epipen.com

Food
Allergy and Anaphylaxis Network (FAAN). How A Child Might Describe A
Reaction. Retrieved July 30,2010 from http://www.foodallergy.org/page/how-a-child-might-describe-a-reaction1